Whilst travelling in the Near East in the years
1183-5, Ibn Jubayrnoted one or more hospitals in
every city in the majority of the places he passed through,
which prompted him to say that hospitals were one of ‘the finest
proofs of the glory of Islam,' (and the madrasas another).[2]

Some twenty or so years before, in 1160, another
traveller, Benjamin of Tudela, found no fewer than sixty well
organized medical institutions in
Baghdad.[3] Earlier, in the Muslim
West, it was said that there were 50 hospitals in Cordoba.[4]

Possibly the earliest hospital in Islam was a mobile
dispensary following the Islamic armies, dating from the time of
the Prophet, a tradition which remained throughout the centuries
of Islamic glory.[5]
The first known hospital in Islam was built in Damascusin 706 by the Umayyad Caliph,
al-Walid Ibn Abd al-Malik. It was to cater for all sorts of
patients including the blind, but also the lepers.[6]
The hospital, its equipment, its staffing and organisation, was
to serve as model for other hospitals to follow throughout the
Islamic world. Hence, in Baghdad, Caliph Harun al-Rashid (r. 796-809) ordered the court physician to
build the Baghdad hospital, a vast endeavour he financed
generously, whilst Caliph Al-Mansur (r. 754-775) instructed his
court physician, Ibn-Bakhtishu to set up hospitals to ‘reflect
the true glory and prosperity of Baghdad.'[7]
In Cairo, the first hospital was established at al-Fustat by Ibn Tulun, governor
of the city in 872. It included a library of 100,000 books,[8]
and had halls divided according to genders, illness, or the
required surgical operation, and two separate baths for men and
women.[9]
After admission, each patient was required to wear special
apparel provided by hospital authorities, while personal
possessions were safely kept until the day of discharge.[10]
In Tunisia, the Aghlabid ruler, Ziyadat Allah I (r. 817-838) built a hospital in
Al-Qayrawanin 830, where for the first time
in history, female nurses were used. It also had a mosque,
spacious wards, its services well indicated for visitors, and
waiting rooms for both visitors and patients.[11]

More hospitals were erected, and by the 12th
century, the institution of the hospital in Islam had reached
very advanced standards as seen in these instances. In
Damascus, the largest hospital, built in 1156 by Nur Eddin Zangi, the Al-NuriHospital, was placed under the direction
of the physician al-Bahili. It was well supplied with food and
medication, and had a well stocked library for teaching.[12]Ibn Jubayradmired most particularly the way
in which the administrator of the hospital kept a register of
patients,[13]
probably the earliest of its kind.[14]

In
Morocco, in 1190, the Almohad ruler, Al-Mansur Ya'qub Ibn Yusuf built a
hospital in Marrakechin a spacious area surrounded by
fruit trees, flowers, herbs, and vegetables.[15]
In this hospital, the historian al-Marrakuchi says, ‘water was
brought in aqueducts to all its sections, besides four pools in
the centre thereof, of which one was built of white marble.'[16]
The daily endowment was thirty golden dinars for the purchase of
food supplies, un-stocked medication, and unpredicted expenses.[17]
Physicians cared for the sick and prescribed diet and
medications, while appointed pharmacists specialised in the
compounding and preparing of drugs. Here, too, patients were
provided with special apparel for the summer and winter seasons.[18]

In Cairo, the Mamluk sultan Qalawun (d. 1290) began the construction of al-MansuriHospital, the largest of all.[19] Masons and carpenters
were brought from all parts of Egypt; loiterers in the street, and passers by, whatever their rank were
obliged to assist in the holy work.[20] When completed, in
1284, this hospital attended 4000 patients daily, had different
wards for diverse diseases, and even applied music therapy on
mentally ill patients.[21]Al-Mansuri is described by Durant:

‘Within
a spacious quadrangular enclosure four buildings rose around a
courtyard adorned with arcades and cooled with fountains and
brooks. There were separate wards for diverse diseases and for
convalescents; laboratories, a dispensary, out-patient clinics,
diet kitchens, baths, a library, a chapel, a lecture hall, and
particularly pleasant accommodations for the insane. Treatment
was given gratis to men and women, rich and poor, slave and
free; and a sum of money was disbursed to each convalescent on
his departure, so that he need not at once return to work. The
sleepless were provided with soft music, professional
story-tellers, and perhaps books of history.’[22]

Major adds that the income devoted to this hospital
by the Mamluk rulers was the equivalent of $100,000 a year, and
that each patient received the equivalent of $12 (1954 value) on
their dismissal from the hospital.[23]

Pushmann acknowledges how the Muslims developed the
hospital institution on efficient lines.[24]
Muslim hospitals, indeed, were managed according to standards
that compare favourably with those of today. Nearly all
hospitals had
separate wards for male and female patients, with different
wards for the different therapeutic branches, such as medicine,
surgery, orthopedics and eye diseases.[25] A separate ward or
pavilion, with barred windows, was used for the care of the
mentally ill, whilst a pharmacy, in the charge of a competent
and licensed pharmacist, was used for both the Out-Patient and
In-Patient services.[26]Care for the patients was
not just during stay at hospital, but also after. At Al-Mansuri
of Cairo, for instance, patients on discharge, were given food and money to help
them compensate for lost income during illness.[27]
The position of the director of the hospital was considered one
of the highest in the government, and as a rule was assigned to
one of the princes, or an officer of the highest rank, and as a
rule these were men of ability and culture, greatly respected,
and ranking with the vizier or minister.[28] Al-Razi, Ibn Sinaand Ibn Zuhr, amongst others,
worked both as hospital directors and deans of medical schools.[29]
The hospitals also housed staff and students, whilst physicians
were paid with regular salaries, and governmental budgets
covered expenses.[30]
Islamic chroniclers kept accurate accounts concerning the
administration of the hospitals in
Baghdad, which allows us to have records of their budgets, including salaries
of the physicians, oculists and attendants.[31]

Hospitalswere the perfect symbol of
universality of health care in Islam, and unlike their
successors elsewhere, they catered for the needs of all, rich
and poor alike, in urban and in rural areas, and freely. This
attitude derives directly from the Qura’nic text which imposes
upon the believer to give care and cure to every human
regardless of their rank in society, including slaves.[32]
For instance, Ibn Abi Usaybi'a speaks of an eminent Syrian
doctor of the 12th century, who, after examining the
sick in the hospital, went to court to treat the important
people.[33]
The constitution establishing the Al-Mansuri hospital in Cairo, also talks of its duty is to give care to the ill, poor, men and women
until they recover, without demand for any form of payment, but
only for the sake of God, the Provider.[34]
There was no distinction for faith or race either, whether in
the provision of care or in the staffing of the hospitals. Staff
came from every background, Christians, Jews, and others, often
holding the highest authority in the institution. Sarton’s
Introduction is an excellent window on such multi-faith
diversity in Muslim hospitals.[35]

Hospitalswere places of care and also of
learning and training. Hence, the leading figures of Islamic
medical science who worked as directors of hospitals also took
the lead in generalising the practice of studying patients and
preparing them for student presentation.[36]
At al-Nuri
hospital
of Damascus, teaching and discussions on topics related to medicine were conducted
by people of great renown.[37]
Some of the physicians at al-Adudi in
Baghdadtook on the task of teaching
‘interns' and students of medicine.[38]
In some of the famous hospitals there was a large hall,
containing manuscripts, where the professors met undergraduate
and graduate medical students for lectures and conferences.[39]
At Al-Mansuri, in Cairo, there was a place where the head doctor gave lectures on medicine.[40]
The hospital itself was manned by interns, residents and twenty
four hour consultants, some of whom were specialists in
ophthalmology, surgery and orthopaedics. They called on the
patients and prescribed for each his daily requirements of diet
and medication.[41]
In that hospital, there was on average one professor of medicine
for every eighteen students in its early stages.[42]
The chief surgeons and physicians also gave demonstrations to
students, examined them and issued diplomas.[43]
Al-Madjusi (d. 994) may be called the father of the medical
'intern' system, for he required that the student be present at
the professor's examinations.[44] He also insists:

‘And
one of those things which are more incumbent on the student of
this art, are that he should constantly attend the hospitals and
sick houses; pay unremitting attention to the conditions and
circumstances of their inmates, in company with the acute
professors of medicine; and enquire frequently as to the state
of the patients and symptoms apparent in them, bearing in mind
what he has read about these variations, and what they indicate
of good and evil.’[45]

As places of learning, the hospitals were also richly
endowed with libraries. Nur Eddin Zangi (r. 1146-1174)
constituted into waqf a large number of books on medicine for
the Al-NuriHospital, which he had founded in Damascus.[46]
This collection was located in two specified spots at the
entrance of the Iwan, and a group of physicians and hospital
employees sat in front of al-Bahili Ibn Ubayd Allah, who then
distributed books out from these two spots for reading.[47] Exchange between
students took place following the reading of such works for as
long as three hours.[48]
Sultan Qalawun (Qala’un) (r. 1277-1290), after having the
hospital constructed, had a madrasa built near it, and fitted it
with a library.[49] He had a librarian
appointed for 40 dirhems a month.[50] Many scholars also
dedicated works to such libraries. Ibn Al-Nafis, for instance,
made his house into a waqf, and gave his books to the al-MansuriHospital,[51] which includes his
major work al-Shamil fi’l Tibb in 300 volumes.[52]

Having looked briefly at the Islamic hospital, which
in its main features and operations, reflects the modern day
hospital, we can safely assert, that this institution was born
under Islam, and not under some previous civilisations,[53] which at no instance
shows one single advanced form of management or operation, or
state involvement, as was the case with the Islamic hospital.
Watts insists that we should remind ourselves that in earlier
times, in the world of Greece and
Rome, there had been no such a thing as
hospitals for ordinary people.[54] Houses for refugees
and the afflicted certainly existed, but hospitals run,
organised and providing care in the modern sense, as in the
Islamic world, certainly did not.

The best Islamic hospitals, Whitty says, were several
centuries in advance of European ones, although to what extent
they directly influenced European practice is difficult to
quantify.[55] Meyerhof, however,
makes an outline of the Islamic impact upon the Christian West
in this field, stressing the role of the crusades.[56] Western
hospitals, he notes, may well
have been imitations of such splendidly installed ‘Bimaristans’
as that of the contemporary Seljuk ruler Nur Eddin in
Damascus.[57] The Mansuri
hospital
of Cairowas much admired by
European travellers of later centuries.[58]
The asylum and hospital ‘Les Quinze Vingt' was founded in Paris
by Louis IX (St Louis) after his return from his unhappy crusade
in 1254-60. Originally intended for three hundred poor blind
men, it had added to it later a hospital for eye diseases which
is now one of the most important in the French capital.[59]
In teaching methods, Muslim hospitals exerted a strong
influence, and Muslim methods with teaching ward rounds in
clinical medical schools have been re-discovered many times,
from the School at Salerno to Sir
William Osler (a great admirer of Ibn Sina) at the end of the 19th century in Canada, the USA
and Britain.[60] They remain the
standard method of teaching Western medicine to this day.[61]

The hospital institution in its rise reflects the
glory of Islamic civilisation. In its collapse it also reflects
the collapse of the same civilisation. In 1258 the Mongol Hulagu conquered Baghdadand made the illustrious
Addudi hospital the centre of his attack.[62] When the traveller,
Ibn-Battuta, visited
Baghdad
in 1330 he found the place in complete ruin, only traces of the
walls were left.[63] That was also the fate
of the city, from once being the glory of Islamic civilisation,
now there was barely a trace of it.